Expert: Dr Ian Jackson - please note UK based - 5/21/2009

Question
hello Dr, perhaps you can help me figure out what is happening.I am a pain mgt patient, have been for several years w/ chronic pain in my shoulders and arms. I receive epidurals approx every 3 months and have been on a regimen of dilaudid- 2mg/6 hr prn and fentanyl patch 75mcg/h- 48 hrs. Was 72 hrs but changed to 48 about a year ago. Other than that the dosages have not been changed. I don't want to increase strength and be on that merry go round so I don't take the dilaudid unless I really need it until an epi can be arranged. On some days if I am in strong pain when I change my patch I will cut the old one in half and tape it to my arm to get an extra boost, thereby keeping my overall load low unless I really need it.It just so happens that on a day when that happened my doctors assistant ordered a urinalysis drug test, the first time that has ever happened after several years of being a patient.She said the insurance required it but the technician doing test said something about seeing how the drugs are metabolized. My question is:
a) can the test discern the higher level of fentanyl on that day? The test was done approx 2-3 hrs after applying the 1/2 patch and it was on for maybe 1/2 hr.
b)why would they order a drug test other than checking concentration or looking for illegal/ illicit drugs? I do use a very slight amount of weed- maybe 1 or 2 puffs /week if I am nauseous.
I also realize that the insurance, legal responsibilities are very stringent for pain mgt docs so there could be a requirement from his insurance carrier.
Any thoughts on this would be greatly appreciated, thanks

Answer
Hi there
I have little experience in Chronic Pain Management and my training in that topic was over 20 years ago. I am therefore sorry but this lies outside my expertise. Also as a UK Consultant I have no experience of your insurance led health service. I am sorry to hear about your problems but cannot really give you any helpful advice about this matter.
Kind regards
Dr Ian Jackson